Magic of skin-to-skin contact – Kangaroo Care could be just what your preemie needs

Kangaroo mother care (KMC) involves an early, continuous, and prolonged skin-to-skin contact between the mother and premature babies; exclusive breastfeeding; early discharge after hospital-initiated KMC with continuation at home; and adequate support and follow-up for mothers at home.1 First suggested by Dr Edgar Ray in Bogota, Columbia in 1978;2 the semantic derivation stems from the way kangaroos (and other marsupials) carry their young ones in their pouches, while the baby is warm, protected and able to suckle whenever it wants to.

Types of Kangaroo Care

There are two types of KMC:

Intermittent: When KMC is done for small periods of time. Used in situations when the baby is nursed in incubators or warmers, and must be transferred to other wards or has been discharged meanwhile requiring care all the way.1

Continuous: Preferably used in preemies where the incubator facility is unavailable. This is the optimal option but the choice of KMC depends upon your preference.1

Components of KMC

Position (skin-to-skin contact):

The baby is placed between the mother's breasts in an upright position. This posture allows the mother to breastfeed the baby as and when is required.

Cover the baby and yourself with some binder or blanket over the chest so that the baby is secure and does not slip out when you stand upright. Also binding over the chest, allows him space for abdominal breathing.

The baby's head should be turned to one side and slightly extended which keeps the airway open.

Keeping the baby in a 'frog' position, with the hips flexed allows the baby to retain the same comfortable posture as in the womb.1,2

Nutrition (exclusive breastfeeding):

Mother's milk is an essential nutritional priority for infants. KMC facilitates exclusive breastfeeding on demand due to the easy access to the mother's breasts. Alternatively, expressed breast milk by cup or nasogastric tube can also be provided to very low birth weight or sick preemies. KMC has also shown to increase milk production in nursing mothers.1,2

Discharge:

Once the baby is feeding well, maintaining stable temperature and gaining weight, the mother can be discharged with the baby in kangaroo position and continue to provide KMC at home. Most infants on continuous KMC can be discharged home earlier, reducing the hospital stay and costs. However, early discharge needs adequate and frequent follow-up visits to the doctor.1,2

Support:

In constant touch with the mother's breasts, provides adequate warmth to the baby. Also, the continuous upward and downward movement of mother's chest during respiration, stimulates the infant's breathing, prevents the need for external warmers and incubators in stable preemies.

KMC allows mothers to keep a watch over the health progress of their preemies. KMC makes it easier for the mother to look out for any body temperature variation, signs of illness, respiratory distress, weight loss, and can quickly access a doctor for the same.

Early discharge from the hospital warrants adequate and frequent follow-up to the doctor. Able support from the family and society, viz. mothers with previous KMC experience can effectively provide adequate social, psychological and domestic work support.1,2

Whom? When? and up to What age?

As a WHO recommendation, infants must be started on KMC immediately after birth, except for severely ill infants, requiring incubator and warmer and other special treatment for their recovery. However, such infants can be started on intermittent KMC or continuous KMC in case the measures for thermal control, feeding and respiratory support are not available. In all cases, timing of initiation of KMC would depend on the region, health system, health facility, of course the parents and the infant.1

KMC continues till the age the preemies reach term (around 40 weeks). This is when the baby shows signs of trying to wriggle and evade out, as it outgrows the need for KMC. The mother is then advised to gradually wean the baby from KMC.1,2

Advantages to1,2

Mothers:

KMC keeps the mother and child together, prevents the stress of separation.

Promotes breastfeeding and allows mother to take better care of their babies.

Fathers:

Fathers can also take part in providing KMC, improves bonding between the baby and the father as well

Infants:

Better, easier, and feasible way of keeping the infant warm and stable